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PAIN AND PAIN MANAGEMENT

Mesothelioma patients and their families many times fear physical pain
as much as the disease itself. It is important to understand, however,
that most cancer pain can be controlled. Nine out of ten cancer patients
will find relief by using a combination of medications. No patient should
have to deal with unmanaged pain.

Causes of Cancer Pain

Pain from the tumor. Most cancer pain occurs when a tumor presses
on bone, nerves, or body organs, and may vary according to location,
(i.e., a small tumor pressing on a nerve or vital organ may cause severe
pain, while a larger tumor elsewhere may cause little discomfort.)

Pain from cancer treatment. Cancer treatments, including surgery,
chemotherapy, and radiation may also cause pain. Painful conditions
are more likely to occur in patients whose immune system has been suppressed
as a result of these therapies.

Pain from other causes. Like everyone else, cancer patients have
pain that has no relationship to their illness. Headaches, muscles
strains, or other aches and pains associated with arthritis, kidney
stones, etc., may cause pain, too. These conditions can normally be
treated along with cancer pain.

Each patient's pain is unique, therefore, it is important that each
individual have a treatment plan that addresses his/her individual needs.
The patient and his/her doctor must work together to reduce unnecessary
pain and improve quality of life.

Types of Pain

The three most common types of cancer pain are:

Acute pain. Defined as pain that comes on quickly and may be severe,
but lasts a relatively short period of time.

Chronic pain. Defined as pain that may range from mild to severe
and persists or progresses over a long period of time.

Breakthrough pain. Defined as pain that occurs in patients with
chronic pain that is controlled by medications.

Pain Control

The type of medicine and the method by which the medicine is administered
will depend on the type and cause of the pain. Following is an overview
of the types of medicines used to relieve pain.

For Mild to Moderate Pain

Nonopioids: Many of these medications are available over-the-counter
(without a prescription); others require a prescription. Some drugs included
in this category are acetaminophen, aspirin, and ibuprofen. Check with
your doctor before using these medications, especially if you are on
chemotherapy.

For Moderate to Severe Pain

Opioids: Also known as narcotics, these may include morphine, fentanyl,
hydromorphone, oxycodone, meperidine, codeine, and methadone. These drugs
are available through prescription only. Nonopioids may be used in conjunction
with opioids for moderate to severe pain.

For Breakthrough Pain

Rapid-onset Opioids: Available by prescription, this is a short-acting
opioid (such as immediate-release oral morphine) which relieves pain
quickly. It is used with a long-acting opioid for persistent pain.

Side Effects of Pain Medication

Most medications have some side effects, although they may affect different
people in different ways and at different levels. Generally, most side
effects will occur in the few first few hours of treatment and then will
gradually disappear. If side effects persist, the doctor may choose to
switch a patient's pain medication to make sure the patient gets maximum
pain control with a minimum of side effects.

Cancer pain is most often treated with opioid medications. Some of
the most common side effects of these drugs are:

Nausea and vomiting: Normally, these side effects occur a day or
two after first taking a particular medicine. If you experience these
side effects, be sure to tell your doctor so that something can be
prescribed to help.

Sleepiness: When first taking opioids, some patients may feel drowsy
or sleepy. For most patients, this side effect will disappear in a
day or two.

Constipation: The best way to prevent constipation is to drink plenty
of fluids such as water or juice, and to eat more fruits (uncooked,
skin on) and vegetables as well as whole grain breads and cereals.
Adding 1 to 2 tablespoons of unprocessed bran to your food may also
help. Exercise to the extent you are able also prevents constipation.
If you still have a problem, your doctor may prescribe a stool softener
or laxative.

More serious side effects are rare, however, if you have trouble breathing,
experience dizziness or a rash, call your doctor immediately.

Ways of Administering Pain Medication

Pain medications may be administered in a variety of ways. Following
are the most common:

Oral. The medicine is taken by mouth in a pill, capsule, or liquid
form.

Transdermal (Skin) Patch. A bandage-like patch is placed on the
skin, continually releasing medicine through the skin over a 2-3 day
period.

Injection. Injections may be administered in one of the following
ways:

Subcutaneous (SC) injection - medicine is placed just under
the skin using a small needle.

Intravenous (IV) injection - medicine is placed directly into
a vein through a needle.

Intrathecal and epidural injections - medicine is placed into
the fluid around the spinal cord (intrathecal) or into the space
around the spinal cord (epidural).

Pump - the patient can help control the amount of pain medication
taken. When pain relief is needed, a computerized pump connected
to a tube in the patient's body is activated by the patient pushing
a button. This allows a preset dose of pain medication to be
delivered.

If one medication or delivery method does not work for you, there is
almost always another one that can be tried. Speak frankly with your
doctor about the pain medicine or method that works best for you. You
may need a different pain medicine or combination of medicines if:

Your pain is not relieved.

Your pain medicine does not start working in the time specified
by your doctor.

Your pain medicine does not work for the length of time specified
by your doctor.